The Importance and Nuances of Temple Fillers
The temples, often neglected aspects of our facial structure, rarely receive the attention they deserve. Unlike other facial features, we don't adorn them with makeup, apply specialized treatments, or pierce them. It's only when we start to notice changes that we give them a second thought.
Typically, we become conscious of these changes when the temples begin to shrink, affecting the surrounding areas. Similar to other parts of the face, the temples lose volume as we age due to the gradual loss of fat pads, collagen, and bone. Given the natural concavity of the temples—actual hollows in the skull—this area may sink more quickly than others, as noted by Dr. Papri Sarkar, a board-certified dermatologist in Brookline, Massachusetts.
Sunken temples can exacerbate crow’s-feet, make the brow appear heavier, and even alter the face's shape, giving it a peanut-shell-like outline. "If you observe children, the forehead is broad, and the rest of the face is plump with healthy facial fat," explains Dr. Jennifer MacGregor, a board-certified dermatologist in New York City. Aesthetic doctors often compare a youthful face to an upside-down triangle, but receding temples disrupt this geometry: "The upper face narrows, and the overlying skin drops, causing the lower face to sag and widen," she adds.
Often, it's the effects of temple atrophy, rather than the hollows themselves, that draw our attention. "People notice the softening and drooping of the lower face but rarely identify the cause," Dr. MacGregor remarks. Similarly, Dr. Sarkar finds that it's uncommon for patients to specifically request temple filler, but many do recognize an overall shape transformation—the peanut-head phenomenon associated with temple hollowing.
Perhaps more notable than the new contour is what it implies. "People subconsciously interpret faces—we make rapid age judgments just by observing head shape from afar, well before we get close enough to see any wrinkles," says Dr. Annie Chiu, a board-certified dermatologist in Redondo Beach, California. "A gaunt, depressed temple creates a concave area that absorbs light, making the face appear more shadowed and less healthy." Moreover, she adds that as the temples collapse, the cheekbones become more prominent, the outer eyelids droop, and the tails of the brows "seem to fall off a ledge, resulting in sharpness in this area."
Injectable fillers, both hyaluronic acid fillers and non-HA volumizers, can restore the temples to their original proportions, softening the face and promoting a more youthful appearance in a subtle manner. However, "the temples are not widely recognized as a crucial area for treatment, especially among newcomers to dermal filler injections," Dr. Chiu informs us. Here are 10 things to know about this influential area before undergoing rejuvenation procedures.
1. Some Individuals Are More Prone to Temple Hollowing
The temporal fat pad "is highly sensitive to cardiovascular activity," notes Dr. Sarkar. "Patients who are extremely athletic or exercise vigorously tend to lose a significant amount of fat in this area, as well as in the cheek hollows and marionette area." When these areas decline simultaneously, the face can appear skeletal. The impact is particularly pronounced in individuals with naturally prominent cheekbones or an excessive amount of cheek filler: the deficits directly above and below these high points can give the face an angular and "ungenerous" Maleficent-like impression, Dr. Sarkar says, which can contribute to an aged look.
2. Filling the Temples Adds Subtle Youthfulness
"Our eyes perceive round objects as younger," Dr. Sarkar continues. Once again, envision a child's face. "When we say someone has 'lost their baby fat,' we're largely referring to their temples and cheeks." Filling the temples restores these curves to a certain extent, she adds, "making people appear friendlier and more accessible."
According to Dr. Chiu, this is "an extremely impactful area for rejuvenation, as it also softens the sharpness of the lateral forehead and brings balance to the midface" by blurring the bony boundaries between temples and cheeks and creating a soft, flowing, crescent-shaped contour that catches the light and brightens the entire face, she states.
For some, temple filler can influence the hairline in the area, encouraging it to move forward slightly. "My patients with very hollow temples often don't realize it, but they stop pulling their hair up because they no longer think it looks appealing," Dr. Chiu says. But as the temples swell slightly, the adjacent hairline progresses forward, creating a more youthful appearance and expanding styling options.
While the overall improvement can be astonishing for patients, "no one else can precisely determine what makes the person look softer, brighter, and more lifted," adds Dr. Chiu. The temples are "probably one of the stealthiest areas [we can treat] without raising suspicion."
3. Temple Filler Isn't Suitable for Everyone
We might make temple filler sound like a mysterious, magical solution with numerous face-enhancing, age-defying, and eye-improving benefits—and it can be. But unlike, for instance, lip filler (in its various forms), this isn't the ideal injection site for everyone. Those with round faces are unlikely to benefit—in fact, plumping the temples could do them a disservice. A natural hollowing of the temples "actually makes full faces appear slightly slimmer and more graceful by highlighting the cheekbones," says Dr. Sarkar. "They require that concavity at the temples to balance the roundness of the face."
4. Temple Injections Can Feel Unusual
Undoubtedly, "filler in the temple region has a peculiar sensation," says Dr. MacGregor. While the injection itself isn't painful, you might "experience more bothersome pressure and sometimes hear a crunchy or crackly sound effect." Depending on their preference, injectors might use a needle or cannula to fill the temples (more on this later). Dr. Sarkar discovers that not everyone can tolerate the feeling of the cannula sliding beneath the skin of the temples. "This area can be more challenging to navigate than other spots, so you might sense more pushing and pulling [despite adequate numbing]," she says. "The feeling of the cannula here truly troubles some people."
5. The Temples Are a Risky Zone
Although no area of the face is completely risk-free for injection, certain areas are more hazardous than others due to the vascular structure of the region. Injecting filler into a facial artery can restrict blood flow to the skin or, in some cases, the eyes, leading to necrosis (skin death) and permanent blindness.
The temples are regarded as high-risk for filler complications. "The superficial temporal artery is an end artery, and accidental injection into this artery can compromise the blood supply to certain parts of the forehead," explains Dr. Chiu. "A more concerning risk is that certain blood vessels in the temple can be connected to those that supply the retina"—meaning there's also a chance of vision loss.
It's extremely crucial that your injector comprehends the anatomy of the temples and knows to target specific planes, placing the filler only at safe depths where there are no vessels. In the temples, this implies injecting either superficially (typically with a cannula) or deeply on the bone with a needle. Doctors might vary their tools and injection techniques based on your anatomy (such as the thinness of your skin and the extent of your hollowing), their comfort level, and the type of filler they're using.
6. There Isn't a Universal Best Filler for the Temple Area
The doctors we interviewed employ various types of fillers in the temples—different HA fillers, Sculptra, and Radiesse, sometimes in combination. The latter two are more effective at stimulating collagen production and tend to provide longer-lasting results—but unlike HA, they aren't reversible with hyaluronidase, so injecting them safely demands above-average skill and expertise.
For most patients with temporal volume loss, Dr. Sarkar frequently relies on Sculptra or diluted Radiesse, finding that they offer a more natural finish than HA—both in the short term and over time. "You have to consider how the product will look, not only upon completing the injection but also as it wears off months later," she says. In her experience, Sculptra and Radiesse tend to wear more evenly than HAs, which can sometimes degrade unevenly, resulting in a lumpy appearance as they fade. Occasionally, when she does use HA in the temples, she places it deeply so "you're less likely to notice any lumps or dimples as it breaks down."
However, there's no one-size-fits-all approach for the temples. Dr. MacGregor prefers injecting the filler deeply so it's "hidden beneath the smooth contour of the temporalis muscle," she says. Dr. Chiu finds that layering Sculptra under Radiesse often provides the most significant and durable correction in this area.
7. The Temples Rarely Receive Stand-Alone Treatment
"It's highly unusual for us to only perform temple filler and consider it complete," says Dr. Sarkar. "If you have considerable temple hollowing, chances are your lower face has likely deteriorated even more than your upper face." To prevent an obvious mismatch and restore a sense of balance, "we need to make it seem as if the same aging process has affected the entire face." And the best injectors achieve this by assessing and addressing the face comprehensively rather than treating specific spots with filler.
The injections that complement temple filler optimally vary from patient to patient. Dr. Sarkar commonly treats the cheek hollows, the lips, and the marionette area simultaneously with the temples. Dr. MacGregor likes to add structure to the cheeks (if necessary), the area in front of the ears, the pyriform space (at the top of the nasolabial folds), and the chin when filling the temples.
All our doctors emphasize the importance of balancing the cheeks and the temples. People tend to get overly enthusiastic about cheek filler, Dr. Sarkar says, because it's such a "cost-effective area" and can create the illusion of a lift. Additionally, cheek filler is often an initial injection for first-timers—and top-ups quickly become a routine cosmetic procedure. But if you continue to enhance the cheeks while disregarding the temples, adds Dr. Sarkar, "things can start to look truly abnormal after a while."
8. Overfilling the Temples Can Be Unsightly
While our doctors state that it's rare for the temples to appear overfilled, especially when the filler is placed deeply, it's not impossible. And when it occurs, "people appear angry and lion-like—it's an aggressive look," says Dr. Sarkar. In her opinion, overfilled temples are often a consequence of injectors going too far in an attempt to smooth adjacent crow’s-feet or visibly "lift" the brow by repeatedly injecting filler into the temples.
When the appropriate amount of filler is injected with the right intentions, adds Dr. Chiu, "temple filler is almost always very natural-looking and simply softens the contour of the lateral face."
